Provider Demographics
NPI:1083749949
Name:HARBERSON, DAVID ALAN (PT)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ALAN
Last Name:HARBERSON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3253 TAFT CT
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-5364
Mailing Address - Country:US
Mailing Address - Phone:303-233-2314
Mailing Address - Fax:303-202-6189
Practice Address - Street 1:7850 VANCE DR
Practice Address - Street 2:150
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80003-2118
Practice Address - Country:US
Practice Address - Phone:303-420-1998
Practice Address - Fax:303-420-1650
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1634225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC20283Medicare ID - Type Unspecified